Citation Nr: 0305386
Decision Date: 03/21/03 Archive Date: 04/03/03
DOCKET NO. 94-25 351 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Jackson,
Mississippi
THE ISSUES
Propriety of the reduction of a 40 percent disability
evaluation for the veteran's low back pain with
spondylolisthesis (currently classified as lumbosacral spine
spondylolisthesis with degenerative disc disease at L5-S1).
Propriety of the reduction of a 20 percent disability
evaluation for the veteran's hypertension.
Propriety of the reduction of a 10 percent disability
evaluation for the veteran's left knee arthralgia with
crepitus.
(The issues of entitlement to a rating in excess of 20
percent for the veteran's lumbosacral spine spondylolisthesis
with degenerative disc disease at L5-S1, entitlement to a
rating in excess of 10 percent for his hypertension, and
entitlement to a rating in excess of 0 percent for his left
knee arthralgia with crepitus will be the subjects of a later
decision.).
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars of
the United States
ATTORNEY FOR THE BOARD
R. K. ErkenBrack, Counsel
INTRODUCTION
The veteran served on active duty from July 1979 to August
1989. A period of active duty from December 1984 to October
1988 is not directly confirmed by such documentation as the
Department of Defense (DD) Form 214, but available service
medical and DD Form 214 evidence indicates prior service that
is consistent with such active duty and the veteran has
indicated this period of active duty on his original claim.
This appeal comes to the Board of Veterans' Appeals (Board)
from a March 1993 rating decision of the Department of
Veterans Affairs (VA) Regional Office (RO) at Atlanta,
Georgia. The Jackson, Mississippi, RO now has jurisdiction
over the claims. The March 1993 decision scheduled the
reduction of the ratings for the disabilities at issue, which
had been proposed by rating decision in June 1992, to be
effective from June 1993. Timely notices of these actions
were sent to the veteran. The reduced (current) disability
ratings are 20 percent for lumbosacral spine
spondylolisthesis with degenerative disc disease at L5-S1; 10
percent for hypertension and 0 percent for left knee
arthralgia with crepitus.
The Board remanded the case in January 2001 for additional
medical evidence and compliance with the Veterans Claims
Assistance Act of 2000. The purpose of the remand has been
met.
The Board is undertaking additional development on the issues
of entitlement to a rating in excess of 20 percent for the
veteran's lumbosacral spine spondylolisthesis with
degenerative disc disease at L5-S1, entitlement to a rating
in excess of 10 percent for his hypertension, and entitlement
to a rating in excess of 0 percent for his left knee
arthralgia with crepitus pursuant to authority granted by 38
C.F.R. § 19.9(a)(2) (2002). When it is completed, the Board
will provide notice of the development as required by Rule of
Practice 903. (38 C.F.R. 20.903 (2002)) After giving the
notice and reviewing your response to the notice, the Board
will prepare a separate decision addressing these issues.
The issues on appeal have been reformulated and clarified, as
stated.
FINDINGS OF FACT
1. A February 1990 rating decision granted service
connection and assigned a 40 percent evaluation for low back
pain with spondylolisthesis, granted service connection and
assigned a 20 percent evaluation for hypertension, and
granted service connection and assigned a 10 percent
evaluation for arthralgia of the left knee with crepitus,
effective August 1989.
2. The February 1990 rating decision was based on clinical
findings during and since active service primarily of low
back pain and muscle spasm with marked lack of flexibility,
hypertension requiring medication with diastolic readings of
100 and 110, and left knee pain on motion and crepitation.
3. After the veteran had been issued a June 1992 notice of
proposed rating reduction, a March 1993 rating decision
scheduled the reduction of the evaluation from 40 percent to
20 percent for the low back disability, 20 percent to 10
percent for hypertension, and 10 percent to 0 percent for the
left knee disability, effective June 1993. This was
confirmed by a September 1993 rating decision.
4. The rating reduction for the low back disability was
based primarily on December 1991 and May 1993 VA examinations
showing no objective indication of low back pain with no
muscle spasm, full lateral flexion, forward flexion to 75
degrees (December 1991) and 90 degrees (May 1993), and normal
gait.
5. The rating reduction for hypertension was based primarily
on December 1991 and May 1993 VA examinations showing
diastolic pressure well below 100 with no additional
cardiovascular complications or symptoms.
6. The rating reduction for the left knee disability was
based primarily on December 1991 and May 1993 VA examinations
showing no objective indication of pain, no crepitation and
full range of motion.
7. Satisfactory evidence warranting reductions in the
veteran's disability evaluations for his service connected
low back disability, hypertension and left knee disability,
respectively, was of record.
CONCLUSIONS OF LAW
1. The rating decision of March 1993 scheduling the
reduction of the evaluation for the veteran's service-
connected low back pain with spondylolisthesis (currently
classified as lumbosacral spine spondylolisthesis with
degenerative disc disease at L5-S1) from 40 percent to 20
percent, effective June 1993, was accomplished in compliance
with applicable laws and regulations. 38 U.S.C.A. §§ 1155,
5102, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.105, 3.344(c),
4.1, 4.2, 4.13 (2002); 38 C.F.R. § 4.71a, Diagnostic Code
5295 (1992).
2. The rating decision of March 1993 scheduling the
reduction of the evaluation for the veteran's service-
connected hypertension from 20 percent to 10 percent,
effective June 1993, was accomplished in compliance with
applicable laws and regulations. 38 U.S.C.A. §§ 1155, 5102,
5103, 5103A (West 2002); 38 C.F.R. §§ 3.105, 3.344(c), 4.1,
4.2 (2002); 38 C.F.R. § 4.104, Diagnostic Code 7101 (1992).
3. The rating decision of March 1993 scheduling the
reduction of the evaluation for the veteran's service-
connected arthralgia of the left knee with crepitus from 10
percent to 0 percent, effective June 1993, was accomplished
in compliance with applicable laws and regulations. 38
U.S.C.A. §§ 1155, 5102, 5103, 5103A (West 2002); 38 C.F.R.
§§ 3.105, 3.344(c), 4.1, 4.2 (2002); 38 C.F.R. §§ 4.20, 4.31,
4.71a, Diagnostic Code 5257 (1992).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
I. Propriety Of Rating Reductions
Where a reduction in an evaluation of a service-connected
disability is considered warranted and the lower evaluation
would result in a reduction or discontinuance of compensation
payments currently being made, a rating proposing the
reduction or discontinuance must be prepared setting forth
all material facts and reasons. In addition, the RO must
notify the veteran that he has 60 days to present additional
evidence showing that compensation should be continued at the
present level, and that he may request a predetermination
hearing, provided that the request is received by the VA
within 30 days from the date of the notice. 38 C.F.R.
§ 3.105. In this case, the RO satisfied these procedural
requirements, as reflected by a rating decision and
notification letter in June 1992.
After completing the predetermination procedures specified in
38 C.F.R. § 3.105(e), the RO must send the veteran written
notice of the final action. This notice must set forth the
reasons for the action and the evidence upon which the action
is based. 38 C.F.R. § 3.105(e). Where a reduction of
benefits is found warranted following consideration of any
additional evidence submitted and the reduction was proposed
under the provisions of 38 C.F.R. § 3.105(e), the effective
date of the final action shall be the last day of the month
in which a 60-day period from the date of notice to the
beneficiary of the final action expires. The RO satisfied
the requirements by allowing a 60-day period to expire before
assigning the reduction effective dates, as reflected by the
rating decision and notification letter in March 1993. This
was confirmed by rating decision in September 1993, of which
the veteran was notified in the original statement of the
case.
Inasmuch as the RO complied with the procedural requirements
of 38 C.F.R. § 3.105(e), the question becomes whether the
reduction was proper based on the applicable regulations.
These regulations provide that rating agencies will handle
cases affected by change of medical findings or diagnoses so
as to produce the greatest degree of stability of disability
evaluations consistent with the laws and VA regulations
governing disability compensation and pension. 38 C.F.R. §
3.344(a). If doubt remains after according due consideration
to all the evidence developed in accordance with paragraph
(a) of 38 C.F.R. § 3.344, the rating agency will continue the
rating in effect. The rating agency will determine on the
basis of the facts in each individual case whether 18, 24 or
30 months will be allowed to elapse before the reexamination
will be made. 38 C.F.R. § 3.344(b).
However, the provisions of paragraphs (a) and (b) of 38
C.F.R. § 3.344 apply to ratings that have been continued for
long periods at the same level (five years or more). They do
not apply to disabilities that have not become stabilized and
are likely to improve. Reexamination disclosing improvement,
physical or mental, in these disabilities will warrant
reduction in rating. 38 C.F.R. § 3.344(c).
The Board notes that the appellant's 40 percent rating for
low back pain with spondylolisthesis, 20 percent rating for
hypertension and 10 percent rating for left knee arthralgia
with crepitus, respectively, were assigned from August 1989
to June 1993. This period is less than 5 years.
Consequently, the provisions of 38 C.F.R. § 3.344(a) and (b)
regarding stabilization of disability evaluations are
inapplicable in this case. 38 C.F.R. § 3.344(c). See Brown
v. Brown, 5 Vet. App. 413, 416-19 (1993).
Having decided that the process required to reduce the
veteran's rating was correctly followed by the RO, the next
question to be addressed is whether, given the available
evidence, such a reduction was warranted. The ratings to be
assigned for reduction in earning capacity are directed
toward specific injury or disease. See 38 U.S.C.A. § 1155
(West 2002); 38 C.F.R. Part 4. To ignore the specific nature
of the disability experienced by the veteran when assigning a
rating violates certain essentials of rating. These precepts
mandate that there be an accurate description of the
disabling condition, with consideration being given to the
whole recorded history such that each of the elements of the
disability to be rated are correctly set forth. 38 C.F.R.
§§ 4.1, 4.2.
In a rating-reduction case, the adjudicator must determine if
the evidence of record shows an actual change in the
disability by reviewing the entire recorded history of the
condition. Not only must it be determined than an
improvement in a disability has actually occurred, but that
such improvement reflects improvement in the ability to
function under the ordinary conditions of life and work. See
Brown, 5 Vet. App. 413. Further, before a rating reduction
can be made, it must be determined that the examinations
reflecting such a change are thorough. 38 C.F.R. §§ 4.2,
4.13.
A. Lumbosacral Spine Disability
Low back pain with spondylolisthesis was rated as 40 percent
disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5295
(1992). Under the rating criteria that were in effect at the
time of the June 1993 reduction, Diagnostic Code 5295
provided that lumbosacral strain with only slight subjective
symptoms warrants a noncompensable rating; with
characteristic pain on motion warrants a 10 percent rating;
with muscle spasm on extreme forward bending, loss of lateral
spine motion in a standing position warrants a 20 percent
rating; and with listing of the whole spine to opposite side,
positive Goldthwait's sign, marked limitation of forward
bending in standing position, loss of lateral motion with
osteo-arthritic changes, or narrowing or irregularity of
joint space, or some of the above with abnormal mobility on
forced motion warrants a 40 percent rating. A 40 percent
rating is the maximum evaluation assignable under that Code.
In the veteran's case, the original 40 percent rating was
assigned on account of findings reported in the service
medical records and on a VA examination in January 1990.
Specifically, service medical records showed that he was
discharged because of low back pain with a marked lack of
flexibility. Spondylolisthesis had been reported on a 1988
re-enlistment examination. The VA examination showed lumbar
paravertebral muscle spasms with limited motion of forward
flexion to 48 degrees, backward extension to 20 degrees,
lateral flexion to 22 degrees, and rotation to 25 degrees.
Straight leg raising was positive at 45 degrees, bilaterally.
X-rays of the lumbosacral spine showed partial lumbarization
of an upper sacral segment on the right and a question of
spondylolysis involving the lower lumbar spine. Residuals of
trauma and spondylolysis of the lumbosacral spine were
diagnosed.
Thereafter, on a VA examination in December 1991, the veteran
complained of low back pain radiating to the neck that was
throbbing, sharp and worse with exercise, and occasional
numbness of the left arm and leg. There was no postural
abnormality or fixed deformity. Back musculature was normal.
Forward flexion was to 75 degrees. Backward extension,
lateral flexion, bilaterally, and rotation were termed full.
There was no objective evidence of pain on motion. Straight
leg raising was negative, sitting, and positive, lying, on
the right at 35 degrees and on the left at 55 degrees. Gait
was normal. He was able to get in and out of a chair without
apparent pain. There was no swelling. The impression from
X-ray was essentially negative lumbosacral spine.
On a VA examination in May 1993, the veteran complained of
episodic lower backache from standing, walking or bending.
Normal range of motion of the spine with forward bending to
about 90 degrees, backward bending to about 30 degrees, side
bending to about 30 degrees, bilaterally, and rotation to
about 30 degrees, bilaterally, was reported. Straight leg
raising was within normal limits, with about 60 degrees on
both sides. There was no postural abnormality nor fixed
deformity. Musculature of the back was within normal limits.
There was no objective evidence of pain on motion. The
diagnosis was lower backache of unknown etiology, possible
myalgia versus arthritis of the spine versus possible disc
problem. Subsequent X-ray findings showed a sacralized
transitional lumbar vertebra at the lumbosacral junction,
borderline spina bifida occulta of S1 and slightly prominent
Schmorl's nodes at L4-5, which had no pathological
significance.
Based on the findings on the December 1991 VA examination,
the RO in a March 1993 rating decision implemented the
previously proposed reduction for the veteran's service-
connected back disability from a 40 percent to a 20 percent
rating. Tellingly, the medical evidence of record at the time
of the June 1993 reduction, as seen on the December 1991 and
May 1993 VA examinations, clearly showed that the veteran's
back disability was not manifested by either listing of the
whole spine to the opposite side, positive Goldthwait's sign,
marked limitation of forward bending in the standing
position, loss of lateral motion with osteo-arthritic
changes, or narrowing or irregularity of joint space, or some
of the above with abnormal mobility on forced motion. See 38
C.F.R. § 4.71a, Diagnostic Code 5295. Nor was severe
limitation of back motion clinically shown as to have
warranted a 40 percent evaluation under other appropriate
diagnostic codes such as Code 5292 for severe limitation of
lumbar spine motion. Manifestations of intervertebral disc
syndrome rated under Code 5293 were not in evidence. The
examiners who conducted the 1991 and 1993 VA examinations
found no evidence of lumbosacral spine disability manifested
by any muscle spasm on extreme forward bending, or loss of
lateral spine motion, unilaterally, in the standing position,
consonant with the reduced 20 percent rating under Code 5295.
There was no objective indication of pain on either
examination. More than moderate limitation of motion of the
lumbar spine rated as 20 percent disabling under Code 5292
was not shown. Accordingly, the veteran did not meet the
criteria for assignment of a 40 percent disability rating for
his service-connected lumbar spine disability at the time the
March 1993 rating decision implemented the rating reduction
in question. The clinical evidence indicated improvement
under the ordinary conditions of life and work based on
thorough examinations. Therefore, the RO's rating reduction,
as confirmed by rating decision in September 1993, was
proper.
B. Hypertension
Hypertension was rated as 20 percent disabling under 38
C.F.R. § 4.104, Diagnostic Code 7101 (1992). Under the
rating criteria that were in effect at the time of the June
1993 reduction, Diagnostic Code 7101 provided that
hypertensive vascular disease (essential arterial
hypertension) with diastolic pressure predominantly 110 or
more with definite symptoms warrants a 20 percent rating;
with diastolic pressure predominantly 100 or more or when
continuous medication is shown necessary for control of
hypertension with a history of diastolic pressure
predominantly 100 or more, a 10 percent rating is assigned.
In the veteran's case, the original 20 percent rating was
assigned on account of findings reported in the service
medical records and on a VA examination in January 1990.
Specifically, service medical records showed that he took
antihypertensive medication for diagnosed essential
hypertension with diastolic readings predominantly below 110
diastolic. The VA examination showed that he was still
taking prescribed anti-hypertensive medication without side
effects or heart complications. Blood pressure was 160/110.
Hypertension was diagnosed.
VA outpatient treatment records dated from 1989 to 1992
showed diastolic readings predominantly below 100 and no
definite symptoms.
On a VA examination in December 1991, the veteran had no
complaints and blood pressure readings were in the ranges of
114-140/83-92. Left ventricular hypertrophy was confirmed by
electrocardiogram. There was no heart enlargement by X-ray.
The apex beat was not beyond the midclavicular line.
On a May 1993 VA examination, the veteran denied any
complications from hypertension. The ranges of readings were
120-128/80-83. An enlarged heart was not clinically evident.
The apex beat was in the 5th intercostal space in the
mid-clavicular line. Electrogram testing confirmed left
ventricular hypertrophy by voltage criteria. Hypertension,
controlled, without any sequelae, was diagnosed.
Based on the findings on the December 1991 VA examination,
the RO in a March 1993 rating decision implemented the
previously proposed reduction for the veteran's service-
connected hypertension from a 20 percent to a 10 percent
rating. Tellingly, the medical evidence of record at the
time of the June 1993 reduction, as seen on the VA outpatient
treatment records dating from 1989 and the December 1991 and
May 1993 VA examinations, clearly showed that the veteran's
hypertension was not manifested by diastolic pressure
predominantly 110 or more with definite symptoms. See 38
C.F.R. § 4.104, Diagnostic Code 7101. It was confirmed on
both the 1991 and 1993 VA examinations that hypertension was
controlled at levels well below 100 diastolic. Accordingly,
the veteran did not meet the criteria for assignment of a 20
percent disability rating for his service-connected
hypertension at the time the March 1993 rating decision
implemented the rating reduction in question. The clinical
evidence indicated improvement under the ordinary conditions
of life and work based on thorough examinations. Therefore,
the RO's rating reduction, as confirmed by rating decision in
September 1993, was proper.
C. Left Knee Disability
Arthralgia of the left knee with crepitus was rated, by
analogy, as 10 percent disabling under 38 C.F.R. §§ 4.20,
4.71a, Diagnostic Code 5257 (1992). Under the rating
criteria that were in effect at the time of the June 1993
reduction, Diagnostic Code 5257 provided that slight
impairment of the knee from recurrent dislocation or lateral
instability warrants a 10 percent rating, the minimum rating.
Where, as here, the rating schedule does not provide a zero
percent evaluation for a diagnostic code, a zero percent
evaluation shall be assigned when the requirements for a
compensable evaluation are not met. 38 C.F.R. § 4.31.
Compensably disabling knee manifestations also include
ankylosis (Code 5256), a dislocated or removed semilunar
cartilage (Codes 5258 and 5259), limited flexion to 45
degrees (Code 5260), extension limited to 10 degrees (Code
5261), impairment of the tibia and fibula (malunion) with
slight knee impairment (Code 5262) and genu recurvatum (Code
5263).
In the veteran's case, the original 10 percent rating was
assigned on account of findings reported in the service
medical records and on a VA examination in January 1990.
Specifically, service medical records showed that he had left
knee pain. The VA examination showed his complaints of the
inability to run and limited standing ability. Flexion of
the left knee was limited to 135 degrees. There was crepitus
on motion. He could only do a partial squat with difficulty
and had difficulty rising on his heels and toes and standing
on the left foot alone. X-rays of the left knee were normal.
Arthralgia of the left knee was diagnosed.
Thereafter, on a VA examination in December 1991, the veteran
showed a normal gait, no swelling or deformity, negative
anterior drawers, McMurray's and Lachman's, and full range of
motion. X-ray showed no definite bony or articular
abnormality and no effusion of the left knee.
On a VA examination in May 1993, the veteran complained of
recurrent knee joint pain after standing or walking for more
than 35 to 40 minutes. No left knee tenderness or deformity
was found. Range of motion was termed normal. No
crepitation was present. There was no swelling or other
impairment of the left knee. Knee joint arthralgia of
unknown etiology was diagnosed.
Based on the findings on the December 1991 VA examination,
the RO in a March 1993 rating decision implemented the
previously proposed reduction for the veteran's service-
connected left knee disability from a 10 percent to a 0
percent rating. Tellingly, the medical evidence of record at
the time of the June 1993 reduction, as seen on the December
1991 and May 1993 VA examinations, clearly showed that the
veteran's left knee disability was asymptomatic and non-
disabling. There was no objective indication of pain on
either examination. Not even slight left knee impairment
under Code 5257 was shown to have been present. There was no
finding of ankylosis, limited motion, semilunar cartilage
abnormality, tibia and fibula impairment or genu recurvatum.
Accordingly, the veteran did not meet the criteria for
assignment of more than a 0 percent disability rating for his
service-connected left knee disability at the time the March
1993 rating decision implemented the rating reduction in
question. The clinical evidence indicated improvement under
the ordinary conditions of life and work based on thorough
examinations. Therefore, the RO's rating reduction, as
confirmed by rating decision in September 1993, was proper.
II. VCAA
First, VA has a duty to provide an appropriate claim form,
instructions for completing it, and notice of information
necessary to complete the claim if it is incomplete.
Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A.
§ 5102; 38 C.F.R. § 3.159(b)(2). In this case, there is no
issue as to providing an appropriate application form or
completeness of the application.
Second, VA has a duty to notify the veteran of any
information and evidence needed to substantiate and complete
a claim, and of what part of that evidence is to be provided
by the claimant and what part VA will attempt to obtain for
the claimant. 38 U.S.C.A. § 5103(a); 38 C.F.R.
§ 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187
(2002). In this case, VA notified the claimant by letter
dated in August 2002 and in a supplemental statement of the
case in October 2002 that VA would obtain all relevant
evidence in the custody of a Federal department or agency,
including VA, Vet Center, service department, Social
Security, and other Federal agencies. He was advised that it
was his responsibility to either send medical treatment
records from his private physician regarding treatment for
his claimed disabilities, or to provide a properly executed
release so that VA could request the records for him. The
duty to notify of necessary evidence and of responsibility
for obtaining or presenting that evidence has been fulfilled.
Third, VA has a duty to assist claimants to obtain evidence
needed to substantiate a claim. 38 U.S.C.A. § 5103A; 38
C.F.R. § 3.159(c). In this case, the veteran's service
department medical records are on file, and his VA treatment
records have been associated with the claims file.
38 U.S.C.A. § 5103A(c); 38 C.F.R. § 3.159(c)(2), (3). There
is no indication that other Federal department or agency
records exist that should be requested. 38 U.S.C.A.
§ 5103A(c)(3); 38 C.F.R. § 3.159(c)(2). The claimant was
notified of the need for VA examinations, and they were
accorded him. 38 U.S.C.A. § 5103A(d); 38 C.F.R.
§ 3.159(c)(4). The veteran was asked to advise VA if there
were any other information or evidence he considered relevant
to his claims so that VA could help him by getting that
evidence. He was also advised what evidence VA had
requested, and notified in the statement of the case and
supplemental statements of the case what evidence had been
received. There is no indication that any pertinent evidence
was not received. Therefore, the duty to notify of inability
to obtain records does not arise in this case. See
38 U.S.C.A. § 5103A(b)(2), (3); 38 C.F.R. § 3.159(e). Thus,
VA's duty to assist has been fulfilled.
ORDER
Reduction of a 40 percent disability evaluation for the
veteran's low back pain with spondylolisthesis (currently
classified as lumbosacral spine spondylolisthesis with
degenerative disc disease at L5-S1) was proper.
Reduction of a 20 percent disability evaluation for the
veteran's hypertension was proper.
Reduction of a 10 percent disability evaluation for the
veteran's left knee arthralgia with crepitus was proper.
The benefits sought on appeal are denied to the extent
indicated.
____________________________________________
CONSTANCE B. TOBIAS
Veterans Law Judge, Board of Veterans' Appeals
IMPORTANT NOTICE: We have attached a VA Form 4597 that tells
you what steps you can take if you disagree with our
decision. We are in the process of updating the form to
reflect changes in the law effective on December 27, 2001.
See the Veterans Education and Benefits Expansion Act of
2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the
meanwhile, please note these important corrections to the
advice in the form:
? These changes apply to the section entitled "Appeal to
the United States Court of Appeals for Veterans
Claims." (1) A "Notice of Disagreement filed on or
after November 18, 1988" is no longer required to
appeal to the Court. (2) You are no longer required to
file a copy of your Notice of Appeal with VA's General
Counsel.
? In the section entitled "Representation before VA,"
filing a "Notice of Disagreement with respect to the
claim on or after November 18, 1988" is no longer a
condition for an attorney-at-law or a VA accredited
agent to charge you a fee for representing you.